u/Paleomedicine

Saw a patient yesterday who has the classic “chronic fatigue” and “chronic joint pain” with a negative million dollar work up. This patient has been seeing a functional medicine clinic, which normally I don’t care about, but yesterday a switch flipped.

This patient believes they have “chronic Lyme disease” despite never being diagnosed with Lyme disease and any testing being negative. We discussed possible fibromyalgia, but of course they want to “get to the root cause.” So they’ve been seeing a “chronic Lyme disease expert.”

Come to find out this “expert” is an RN. Not an NP or PA or MD. But an RN passing herself off as a “holistic practitioner.” I have NO idea how this is even legal. I told the Patient point blank this person does not have the training to be an expert on it and furthermore the patient has been through a battery of expensive tests and “treatments” to the tune of thousands of dollars with none of it making a lick of difference or being “inconclusive.”

How is this even legal??

Part rant, part asking, what smart phrases do you have for patients that send inappropriately long MyChart messages?

And for the future crap, how do you tell people to hold off on putting their results into AI before you even have a chance to review them?

I know this is a classic ethics question and usually I say I have to discuss it with the patient to get a clear picture but curious how others approach it?

I tried to recertify my PAYE plan as I’ve been on it since 2020 and have 60 payments towards PSLF. I applied via the FSA website then received the following email from Mohela.

"MOHELA received your request for an income-driven repayment (IDR) plan. We are unable to grant your request for the following reason(s): · Your repayment plan has changed, and your monthly payment amount has been recalculated. Based on the information provided on your Income-Driven Repayment Plan Request, you no longer have a partial financial hardship to qualify you for the income-driven repayment plan you were previously enrolled in. Your loans will be placed on an IBR/PAYE Permanent Standard repayment plan. A notice with details of the new repayment plan, including the new monthly payment amount, will be sent separately."

They were already estimating a new payment and it hasn’t changed, but has anyone else received this email? And what does it mean? I’d love to save a 4 hour phone call with Mohela.

Does anyone have any good resources on this program? I have patients asking about it but I can’t find any consistent guidelines.

This may be a personal thing because I’m also more introverted but when Saturday comes around, I’m so drained from the work week, I find it hard to make time for family and friends. In residency it was really bad and as an attending I still feel like my social battery is drained after a week of work and the only way to recharge is spending time with my SO and hobbies. Unfortunately plans with friends or family cuts into that and while I feel bad, it cuts into that recharge time and I don’t feel as rested for the work week.

Anyone else feel the same?

I used to watch Pokepics back between 2008-2011 and I really enjoyed his channel. He was so enthusiastic about artwork rather than the value of a card. Now when I see videos, they have a little value ticker and I hate seeing that. Any recommendations for YouTube channels that focus more on the artwork?

Y’all im so tired of the phrase “my physician didn’t listen/ doesn’t listen to me.” I had a man who no longer wishes to be a patient because apparently I didn’t listen to them about a problem they were having. They had chronically low white counts, which I specifically discussed in my note, and referred them to hematology. But despite all that, they don’t feel like I “listened” to them.

I know it’s ultimately fine because they weed themselves out, but damn is this an infuriating experience and process the first years as an attending.

I make sure to listen and explain as much as I can no matter what a patient brings up and if I can’t, I tell them we can pursue it at their next visit. Many people appreciate this, but for some, I guess I don’t “listen.”